Frequently Asked Questions about the Mandated Assessment of Risk of Suicidality and Self Harm (MARSSH) Protocol
Why me? I know lots of students who do what I've done.
It's true, you may know of other students who need help more than you do, or who have engaged in riskier behaviors. Maybe a report was written about you because you cut yourself one time, but you know of other students who cut regularly, who have taken pills, burned themselves, mentioned a wish to die or to hurt someone else, are starving themselves, have blacked out from alcohol consumption, or any number of other behaviors that seem more serious to you than your situation. If there's someone you're worried about, we hope you'll encourage him or her to take advantage of counseling, too. But since someone reported concerns about your behaviors, we want to do all we can to insure your well-being and that of concerned others around you.
I've been in counseling before, and I didn't like it. If you send me to CHWS, I'll just sit there. Why are you still requiring that I go?
Developing trust in your relationship with a clinician is key to this process being helpful. It may be that your prior experience really was a poor fit between you and your therapist, or that you (rightly) did not trust what you said to remain confidential. It's pretty common for families to send their children to their own therapist for help or to someone who is a friend of the family. (We think that's less than ideal for establishing trust.) If the fit with the first clinician you meet isn't right, you are welcome to request a shift to someone else on- or off-campus.
What happens if I go to CHWS, and after one or more sessions, my clinician determines that I've not complied with treatment?
Not only may you choose to engage in your assessment with a provider off-campus, the University may decide that such a plan is desirable. For example, sometimes a student needs more focused attention than we can provide in an outpatient, campus clinic. They may need to be seen more than once a week, or may be in immediate need of stabilization in a hospital or treatment center before weekly therapy is appropriate. A student may also have come to CHWS in the past and not have been a good fit for the treatment provided. For example, (s)he may not have complied with medical and/or psychological treatment recommendations or may have behaved inappropriately with CHWS staff in some way.
It may also be that a student appears for the appointment(s), but does not make a good-faith effort to participate in the assessment. A student who is chronically late for appointments, re-schedules or no-shows multiple times may also be referred out. Any of these circumstances may mean that the CHWS clinician determines you must complete the mandated suicide assessment with an off-campus provider.
If this should happen, you'll need to begin your four sessions over again with a clinician in the community. You may wish to ask your prior clinician for specific feedback about what would need to proceed differently in order for you to satisfy the University's requirements. Ultimately, failure to complete the assessment could result in further action by the University, but the hope is that if CHWS is not the ideal place for you to get your assessment, that you will simply get the recommended evaluation or treatment in the setting that is right for you.
How can you un-enroll me from my academic classes, based on my social behavior?
The two are inter-twined. We recommend you carefully read Standard Two of the Integrity Code. So for example, students who are on academic probation are sometimes disallowed from co-curricular activities like athletics, theater, leadership positions, clubs, or any other activity by which they might represent the university. We look upon disenrolling students who are struggling as a responsibility for us, not as a punishment for them. It would be irresponsible of us to let someone who is failing classes and not making progress towards a degree invest all his or her time as a club president while they pay full tuition. Similarly, to let someone who is struggling emotionally keep plugging along in classes until a major trauma occurs would be unfair to the person and to the people around them.
What happens to the tuition money we paid if I get disenrolled from my classes?
The University publishes a schedule that shows the percentage of tuition that is returned to students depending upon the point in the semester at which they depart campus. Please consult the Logger for these specific figures.
What happens if I'm participating in the assessment like I'm supposed to, and a new Suicide Incident Report (SIR) is written about me?
If this were to happen, the SPT would consider further sanctions for you, up to disenrollment from your classes. Although the Committee would acknowledge that you were following through with the required assessment, it would become increasingly concerned with your behavior (even during the process of an assessment.) If the SPT receives repeated reports of risky behavior, sanctions are likely to escalate in an effort to protect your health and the welfare of those around you.
It may look to other people like I am harming myself, but I have no intention of dying. Do I still go through this if I'm honestly not suicidal?
Yes, because your behavior caused others concern. Only you will know whether you were intending to really do yourself harm, and whether you might ever plan to do so. The SPT is paying attention to your behavior, not trying to read your intention. We cannot expect your peers or faculty to interpret your behaviors or diagnose your level of distress, either. You may speak with the clinician you work with about what you were actually thinking, and how you feel about how things have turned out (including about getting this letter.) But frankly, if your behavior has worried others, it's a high priority for us. We need the community to feel safe to all, whether or not you are actually at high risk. For example, sometimes students who have anorexia don't realize how deeply their health issues are affecting those around them.
Okay, honestly, I was suicidal for a bit there, but I'm fine now. Do I still have to get an assessment?
Yes. Many students mention suicidal feelings in the course of participating in psychotherapy, and we know that this is not the same as planning to kill one's self. We all develop some self-destructive ways of coping at times, when things aren't going well. This is a chance to talk about what patterns you've developed and what more effective coping strategies you might add to your repertoire.
So what if I am suicidal? It's my right to take my life if I choose to do so.
We know that only you have ultimate control over how you interact with your body. But you do not have the right to engage in behaviors that harm you (and therefore those around you) while a member of our campus community without some consequences. Your student status is a privilege you have earned (and can lose), not a right that you remain entitled to regardless of your academic performance or behavioral choices.
Why does Puget Sound have this policy?
This model was adopted by the University of Washington, the University of Puget Sound and several other institutions at the same time. It's an approach that originates at the University of Illinois, where it resulted in decreasing student suicides by 50% over a number of years. The policy has the potential to help Puget Sound students, too.
Why are faculty, staff and students keeping such a close eye on my welfare? Does this campus have a history of suicides?
Based upon the expected number of college suicides by size of student body, the Puget Sound community has experienced slightly fewer suicides than would be expected, thank goodness. But we care about our students and hope for that number to be zero. We believe that getting students support when they need it is important; that's why folks are paying close attention. We really hope for students to enjoy and benefit from their Puget Sound experience, not just to survive it; health -- both physical and emotional -- is a huge part of that equation.
How can you say the assessment is "confidential" if I have to give you permission to tell the Suicide Prevention Team whether I've come or not?
It's called a consent for release of information, and on it we write a "check mark" next to only those things the clinician needs authorization to communicate to the SPT. (S)he will specify the minimum information required. The clinician will need your permission to confirm that you have completed the MAS protocol, but (s)he can't (and wouldnt want to) share anything about the nature of what you'd discussed. Without your written consent, the clinician can't even acknowledge that (s)he knows you!
You should be aware that there is certain information a clinician is required to report: If you are assessed to be at imminent risk of harming yourself or others, if you report ongoing abuse of children or dependent adults, or if there is a court order of your record. So you're right, mandated assessments are not 100% confidential in the sense that the clinician will need to reassure the Suicide Prevention Team that you are following-through, but this need not cause disruption to the trust in your counseling relationship.
I want to appeal. How may I go about that?
As noted in the letter you received from the SPT, you may appeal this action to the Dean of Students. This must occur within 24 hours of your having received this letter. When you make this formal appointment, the Dean or his designee will communicate what else may be required of you (if anything) in preparation for this meeting.